The North Carolina Coalition on Mental Health, Developmental Disabilities and Substance Use Services submitted budget recommendations to the North Carolina General Assembly House and Senate Appropriation Chairs on January 13, 2021: The Coalition budget priorities 2021 FINAL
In 2019, The Coalition distributed a list of budget priorities to the General Assembly as we have done for the decades of our collaboration. These priorities were carefully outlined and agreed upon by over 32 organizational members as a means to ensure that people can be adequately served by the MH/IDD/SUD community in North Carolina. The priorities supported services that better influence the lives of individuals and families in need, providers both large and small, and ultimately healthier communities. At the time of the letter, COVID-19 was not on anyone’s radar. Now, in 2021, more than ever, healthcare equity is needed as more people are unemployed and uninsured and in desperate need of services. These people include the disproportionately affected, historically marginalized communities including those with disabilities who have had long-standing disparities in access to quality health care.
The Coalition’s 2021 budget request includes priorities that remained unresolved after many years of advocacy as well as new priorities for the times we find ourselves in. These priorities support North Carolina’s Olmstead Plan which is required for compliance with the U.S. Supreme Court’s Olmstead ruling. An Olmstead Plan addresses the institutional bias and lack of access to MH/IDD/SUD Home and Community Based services for tens of thousands of North Carolinians. The waiting list for those needing services continues to grow and individuals and families are more in need than ever. Provider agencies are working within the limits of their thin operating margins to address the cost of services for insured and uninsured individuals – without additional fiscal support.
More than $500,000,000 in “Single Stream” funds have been cut from the State-funded services for those without other health coverage over the last five years. Additionally, the state is operating on the 2018-2019 spending levels. None of this accounts for the growth in people needing services, including a 12% increase in Medicaid program enrollment in 2020 due to job losses and the public health emergency.
In response to COVID-19, Congress and the NCGA authorized a 5% Medicaid provider rate increase. However, this 5% increase does not include providers in the Mental Health, Intellectual and Developmental Disabilities, and Substance Use Disorder arena. Our provider community is under managed care and receives reimbursement from the LME/MCOs based on their per member per month capitated rate, unlike other Medicaid State Plan services. MH, IDD, and SUD providers are experiencing the same financial stress as hospitals, nursing homes, and primary care physician practices. Clinics are competing for expensive PPE resources, implementing special COVID infection prevention measures for clients living in congregate settings, and struggling to keep their direct care workers employed and their patient or client populations out of hospital emergency rooms. More support is needed so that current services do not have to end.
The NCGA can provide additional funding in the Medicaid program rebase to increase the per member per month capitation rate paid to LME/MCOs, restore Single Stream funds to previous levels, and address the other priorities set forth in this document. Our community is already seeing a behavioral health service utilization surge as a result of the pandemic, and that surge is likely to extend for several years.